Choose the Coverage That Fits Your Strategy
Whether you’re carving out pharmacy, capping its cost or protecting against volatility, WriteWise has a solution for every self-funded group.
The WriteWise Solutions
PMPM Guarantee
- What it is
- A guaranteed maximum pharmacy cost per member per month, backed by WriteWise
- Best when
- The group is self-funded and wants to cap its pharmacy spend
- Data needed
- Drug-level (NDC) claims
- What the client gets
- A fixed, budgetable pharmacy cost with no surprise spikes.
The WriteWise PMPM Guarantee turns a PBM contract into fully underwritten, fixed-cost pharmacy protection. We validate PBM pricing at the NDC level and cap total Rx liability at a reconciled PMPM rate, removing volatility and exposing hidden PBM margin and stop-loss mispricing.
The result: a fixed, budgetable pharmacy cost, with WriteWise paying anything above the cap. Groups that carry stop-loss also typically see rates drop 15–25%, giving brokers a clear edge in every sale. For the first time, a PBM’s ability to drive down net cost ties directly to what the client pays.
Spend capped at a reconciled PMPM
Live monitoring and a year-end audit
Lower stop-loss rates for groups that carry it
RxProtect
- What it is
- Pharmacy-only stop-loss, backed by an A-rated carrier
- Best when
- Pharmacy is bundled in a BUCA ASO, or drug-level data isn’t available
- Data needed
- Drug-level claims, or monthly totals plus the top 25 drugs (9+ months)
- What the client gets
- Protection against pharmacy claim spikes, separate from medical stop-loss
Traditional stop-loss is designed for medical claims, not pharmacy. With specialty drug costs rising and PBM contracts opaque, pharmacy risk is hard to price and control in a bundled ASO arrangement. RxProtect protects self-funded plans from pharmacy volatility, especially when medical and pharmacy stop-loss don’t align.
It’s built for ASO groups carving pharmacy out of BCBS or other bundled carrier arrangements, with simple administration and competitive rates.
No drug-level claims? RxProtect can be written on monthly totals plus the top 25 drugs, with at least 9 months of history.
- Pharmacy-only stop-loss
- Backed by an A-rated carrier
- Ideal for carved-out or specialty-heavy populations
- Third-party validated claims auditing
Essential Suite
Add subscription pharmacy coverage to MEC or limited medical plans. Billed monthly.
Basic
Entry-level coverage for core pharmacy needs
- Access to 700+ drugs
- HIV, Chemical Dependency, Migraine, Eye, and Antiviral Agents
- Insulin and Diabetic Management
Premier
Broader formulary
- Access to 1,200+ drugs
- HIV, Chemical Dependency, Migraine, Eye, and Antiviral Agents
- Insulin and Diabetic Management
Premier+
Most popularOur most complete essential formulary
- Access to 1,400+ drugs
- HIV, Chemical Dependency, Migraine, Eye, and Antiviral Agents
- Insulin and Diabetic Management
Preferred
51–250 employees
Coverage for most essential and specialty medications
- Brand and specialty drugs
- Best market coverage rates
- Fully open formulary
Get an Essential quote
A short form, no platform account needed.
Richer coverage that includes brand and specialty drugs. Optimal Closed is for groups under 50 employees, Optimal Open for 51–250 employees written as spec + agg, and Optimal gives fully insured groups of 250+ members a pre-underwritten rate to move to self-funding.
Closed
Under 50 employees
Four fixed formularies based on 30-day drug costs, with coverage rates from ~76% to ~93%
- Brand and specialty drugs
- Best market coverage rates
- Fully open formulary
- Choice of four formularies
Open
Most popular51–250 employees
Fully open formulary with a monthly benefit individual (MBI) cap
- Brand and specialty drugs
- Best market coverage rates
- Fully open formulary
- MBI caps of $500, $1,000, $2,000 or $5,000
Get an Optimal quote
A short form, no platform account needed.
The market is moving to self-funding
“In the past year alone, self-funded plans added over 2 million members, while fully-insured lost 1.5 million – the momentum is clear, and the market is moving.”
“The self-insured market is projected to grow from ~117.1 million covered lives in 2025 to ~122.2 million by 2032, while the traditional group coverage base is expected to decline.”
Bringing Financial Certainty to Rx
Lock in a predictable pharmacy cost with a guaranteed PMPM.